The overall objective is to support a seven year multi-centered randomized clinical trial in association with a prospective registry. This program will examine the role of Lung Volume Reduction Surgery (LVRS) in the treatment of end-stage emphysema, evaluate the long term outcome of LVRS on function, morbidity and mortality and define appropriate patient selection criteria for the procedure. A secondary objective is to define which patients benefit most from the surgery. The study population will consist of 2,600 patients. The study will be conducted in three phases. Phase I (9 Months) will be for development of a protocol and manual of operations and recruitment and training of personnel. During this phase the clinical centers will collaborate fully with other clinical center investigators and the clinical coordinating center investigators in the development of the study protocol and manual of operations. Phase II (63 Months) will be for recruitment of patients, randomization and follow-up of subjects. Phase III (12 Months) will be for analysis of data and writing of manuscripts describing results of the study. During phase III, clinical center staff will collaborated with other study investigators and the project officer to conduct the final analyses of the data and to write manuscripts describing results of the study.